The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease

The accuracy of clinical diagnosis for pelvic inflammatory disease was determined in 95 women who presented with pelvic pain to primary care physicians and then were referred to gynecologists. Laparoscopy or laparotomy with endometrial biopsy and fimbrial minibiopsy revealed that prevalence of pelvic inflammatory was 46% (44/95) and positive and negative predictive values of gynecologists were 74% (23/31) and 67% (43/64) (p = 0.0002). If histopathologic diagnosis was the standard, clinical accuracies of the gynecologists were no better than chance (p = 0.43), suggesting an expectation bias for visual diagnosis. Laparoscopy had a sensitivity of 50% (12/24) and a specificity of 80% (40/50) for salpingitis if the standard was fimbrial histopathologic diagnosis (p = 0.01). These results support the routine use of laparoscopy, supplemented when negative by endometrial and fimbrial minibiopsy, to accurately diagnose pelvic inflammatory disease.

Detection of Chlamydia trachomatis antigens in urine as an alternative to swabs and cultures

By using commercially available spectrophotometric and immunofluorescent immunoassays, Chlamydia trachomatis antigens were detected in first-void urine (FVU) sediments from 224 men attending a sexually transmitted disease clinic at a frequency of 81.6%-86.8% compared with 86.8% (33/38) positive by urethral swab culture (P less than .05). Endocervical cultures from 228 women attending a gynecology clinic yielded 92.3% (12/13) positive compared with 61.5%-76.9% for urine samples in three antigen-detection assays. Culturing urine from either gender yielded low positivity rates (23.7% for men, 15.4% for women). Defining truly infected patients as positive by culture or by any two of the three antigen tests, all assays were 100% specific. Immunodiagnostic testing of male FVU sediment appears to be a reliable, rapid, nontraumatic method for diagnosing chlamydia infection.

Dysmorphism of urinary red blood cells--value in diagnosis

To aid investigation into the clinical problem of hematuria, assessment of abnormalities in the shape of red cells in the urine (dysmorphism) is gaining popularity in nephrology. However, there is uncertainty in the literature regarding both the number of red blood cells (RBC) in normal urine, as well as the quantification of dysmorphism. We have shown that in normal urine (N = 27) the number of RBC is less than 2,000/ml as assessed by scanning electron microscopy of filtered urine specimens from normal volunteers without known renal disease, which compared to less than 1,000/ml by centrifugation and phase contrast microscopy of the same specimen. To determine whether dysmorphism of urinary red blood cells was a significant predictor of glomerular disease we compared the number of dysmorphic cells in the urine of patients with biopsy proven glomerulonephritis (GN), before and immediately after renal biopsy. We also compared the number of dysmorphic cells in patients with glomerulonephritis to those with lower urinary tract bleeding. Renal biopsy caused significant dysmorphic hematuria, indicating that dysmorphism suggests renal rather than glomerular bleeding. Although patients with GN had significantly more dysmorphic urinary RBC when compared to those with lower tract urinary bleeding, the overlap was such that one could only be confident of renal hematuria if they accounted for greater than 75% of the total number of RBC. Non renal hematuria is present if number of dysmorphic cells is less than 17% of total RBC. Thus dysmorphism of urinary RBC is a useful diagnostic tool, but only if strict criteria established for each laboratory are adhered to.

A clinical virology database for a regional virology service

We describe a laboratory information system employing a virus and chlamydia database developed over seven years which is used by a regional laboratory, performing virus and chlamydia testing. The information system is implemented on a University mainframe computer and accessed by computer terminals in the laboratory. The database is used to identify patients, store patient test results, minimize clerical work and improve accuracy of reported results. The database also serves as a patient registry for use in education and research.

Diagnosis of Chlamydia trachomatis genital infections by cell culture and two enzyme immunoassays detecting different chlamydial antigens

The enzyme-amplified immunoassay IDEIA (CellTech Diagnostics), which measures lipopolysaccharide antigen, and Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.), which measures several antigenic components of Chlamydia trachomatis, were compared for specimens from urethral swabs from 235 men attending a clinic for sexually transmitted diseases (culture prevalence of 14.9%) and 458 endocervical swabs from women attending planned parenthood and obstetrics-gynecology clinics (culture prevalences of 5.9 and 7.7%, respectively). Compared with cell culture, the percent sensitivites, specificities, and positive and negative predictive values for IDEIA were 62.5, 99.5, 95.2, and 94.3%, respectively, for specimens from men and 96.3, 97.9, 74.3, and 99.8%, respectively, for specimens from women; results for Chlamydiazyme for specimens from men were 81.8, 99.5, 96.4, and 97.1%, respectively, and for specimens from women, results were 85.2, 99.3, 88.5, and 99.1%, respectively. Although the specificities of IDEIA and Chlamydiazyme were comparable, the sensitivity of IDEIA appeared higher for women (96.3%) than for men (67.5%), while the sensitivities of Chlamydiazyme were similar for men (81.8%) and women (85.2%). Western blot (immunoblot) analysis of the detector reagents from the two immunoassays indicated that the differences in performance observed for the two immunoassays may be due to measurement of different antigens.

Characteristics of different solid-phase immunoassay formats for the measurement of BK virus immunoglobulin M in sera of patients on renal dialysis or with kidney allografts

Solid-phase immunoglobulin M (IgM) antigen capture enzyme immunoassay (AgCEIA) and antibody capture enzyme immunoassay (AbCEIA) were developed for the diagnosis of BK virus (BKV) infections. Of 37 serum samples from renal allograft recipients, 15 were positive for BKV IgM antibody by either AgCEIA, AbCEIA, or antigen capture radioimmunoassay. False-positive IgM results were observed in the AgCEIA in the presence of high levels of BKV IgG antibody (titers greater than or equal to 1:51,200), when rheumatoid factor (RF) titers were greater than or equal to 1:20, or in the presence of high levels of RF (titers greater than or equal to 1:10,240) when BKV hemagglutination inhibition titers exceeded 1:40. False-positives due to RF could be eliminated by treatment of sera with anti-human IgG antisera or IgG-coated latex particles. The presence of RF did not, however, produce false-positive results in the AbCEIA. Both AgCEIA and AbCEIA were specific for BKV IgM antibody, as 14 serum samples containing either JC papovavirus, cytomegalovirus, rubella virus, hepatitis A virus, or hepatitis B virus core IgM antibody were negative in both EIAs. Comparison of results obtained for 37 serum samples revealed 14 positive by radioimmunoassay and 11 positive by both AgCEIA and AbCEIA. Both EIAs detected BKV IgM antibody in sera of renal allograft patients and patients on renal dialysis who had reactivated BKV infections persisting for several months after transplantation.

Comparison of three protein A-gold immune electron microscopy methods for detecting rotaviruses

Three immune electron microscopic (IEM) methods employing protein A-colloidal gold (PAG) were compared with direct electron microscopy (DEM) and direct IEM (DIEM) techniques for their abilities to detect simian rotavirus (SA11) and human rotavirus. Using PAG IEM the number of rotavirus particles per grid square was 10 to 50 times and 2 to 5 times higher than observed with DEM and DIEM, respectively. A comparison of sensitivities among the three PAG IEM methods showed that the trapping efficiency for SA11 and human rotavirus was significantly enhanced by a serum-in-agar (SIA) method. The SIA method appeared to be a more reliable and sensitive alternative for detection and quantitation of viral particles.

Nasopharyngeal swabs and nasopharyngeal aspirates equally effective for the diagnosis of viral respiratory disease in hospitalized children

Paired nasopharyngeal swab and nasopharyngeal aspirate specimens from 125 patients were compared for viral diagnosis. The viral isolation rates were comparable for the two types of specimens. There was a high level of agreement between the two specimens in overall positivity rate by immunofluorescence and positivity in culture-confirmed patients.

Agreement study between two laboratories of immunofluorescence as a confirmatory test for human immunodeficiency virus type 1 antibody screening

A total of 114 serum specimens from 76 blood donors, 21 patients with acquired immune deficiency syndrome or acquired immune deficiency syndrome-related complex, 7 multiply transfused patients, 3 hemophiliacs, and 7 others were tested for anti-human immunodeficiency virus type 1 (HIV-1) antibody by enzyme immunoassay (EIA) and Western blot (WB) and then blindly tested by immunofluorescence (IF), independently, in two separate laboratories. The IF technique used acetone-fixed HIV-1-infected E cells and uninfected HUT-78 cells mixed at a 1:3 ratio in one spot on a glass slide and uninfected HUT-78 cells (to assess nonspecific fluorescence) alone in a second spot. Of 114 serum specimens, 85 were repeat EIA positive, and 21 of these were WB positive. A total of 129 of 134 of the IF results (included were 20 duplicates) were identical between laboratories, for a Kappa agreement statistic of 0.93. All five IF results discordant between laboratories were EIA repeat positive and WB negative. Included in the study were eight WB-indeterminate sera, of which five blood donor serum specimens and one hemophiliac serum specimen were IF negative and two acquired immune deficiency syndrome serum specimens were IF positive. As a confirmatory test for HIV-1 antibodies, IF provided a faster alternative or supplementary test for confirming EIA results.

Ability of TESTPACK ROTAVIRUS enzyme immunoassay to diagnose rotavirus gastroenteritis

TESTPACK ROTAVIRUS, a simple 10-min enzyme immunoassay, was compared with electron microscopy and Pathfinder enzyme immunoassay on feces from 172 patients of various ages with gastroenteritis. The percent sensitivities and specificities before blocking with antiserum were as follows: TESTPACK, 100% sensitivity and 99% specificity; Pathfinder, 95% sensitivity and 98% specificity. After blocking, the sensitivity and specificity, respectively, were 100% and 100% for TESTPACK and 95% and 99% for Pathfinder. TESTPACK ROTAVIRUS was more sensitive, but not significantly, than Pathfinder (P greater than 0.1) and the direct electron microscopy technique (P greater than 0.1).

Comparison of three immunosuppressive regimens in cadaver renal transplantation: long-term cyclosporine, short-term cyclosporine followed by azathioprine and prednisolone, and azathioprine and prednisolone without cyclosporine

We conducted a randomized trial in seven Australian hospitals of the efficacy and safety of three immunosuppressive regimens after first transplantation of a cadaver kidney: long-term cyclosporine, short-term (three months) cyclosporine followed by azathioprine and prednisolone, and azathioprine and prednisolone without cyclosporine. Patients assigned to long-term cyclosporine (n = 138) or short-term cyclosporine followed by azathioprine and prednisolone (n = 141) had similar actuarial 12-month survival (98.4 vs. 96.4 percent) and graft survival (83.9 vs. 82.1 percent). Patients assigned to receive only azathioprine and prednisolone (n = 138), with optional use of antithymocyte globulin, had a significantly poorer survival rate (91.3 percent, P = 0.015) because of deaths from cardiac causes and infection, but their graft survival of 76.0 percent (P = 0.31) did not differ significantly from that of either group receiving cyclosporine. After the switch from cyclosporine to azathioprine and prednisolone, 15 percent of patients had reversible rejection episodes, but the frequency of rejection and graft loss did not differ from that in the long-term cyclosporine group. After the change to azathioprine and prednisolone, serum creatinine levels declined in nearly all patients, so that after three months they were comparable to those in the group receiving azathioprine and prednisolone only, and significantly lower than those in the group receiving long-term cyclosporine therapy (P less than 0.003). We conclude that the two cyclosporine regimens result in comparable patient and graft survival, but that changing to azathioprine and prednisolone at three months improves graft function.

Diagnostic significance of anti-HBcIgM prevalence related to symptoms in Canadian patients acutely or chronically infected with hepatitis B virus

A total of 362 sera from 295 Canadian patients were examined for HBsAg, anti-HBs, anti-HBc, anti-HBcIgM, HBeAg, and anti-HBe using commercial immunoassays. Serial samples from 70 acutely infected patients demonstrated that anti-HBcIgM may detect 10% more positives than HBsAg within 4 months after the onset of clinical symptoms, and all except two were negative for anti-HBcIgM after the fourth month. None of 66 asymptomatic (HBeAg rate 18.2%) and two of 14 (14.3%) symptomatic (HBeAg rate 64.3%) carriers of HBsAg were positive for anti-HBcIgM (P = 0.029). Elevated marker responses were measured in two symptomatic carriers for a 20-month period. Anti-HBcIgM was not detected in either 100 asymptomatic patients positive for total anti-HBc, negative for HBsAg and negative for or possessing low levels of anti-HBs, 25 patients with liver disorders not caused by HBV, or 20 healthy milk donors. In diagnostic laboratory practice this anti-HBcIgM test may be useful in the following situations: to supplement HBsAg testing, providing a theoretical 10% increase in positives within 4 months following onset of acute viral hepatitis; to replace testing for anti-HBc and anti-HBs in symptomatic HBsAg-negative patients; to confirm whether a patient is experiencing acute or chronic HBV infection or symptoms superimposed upon asymptomatic HBsAg carriage by another cause, such as nonA-nonB viral hepatitis.

Assessment of serologic markers for Epstein-Barr virus

Antibody responses to early antigen (EA) and viral capsid antigen (VCA) were analyzed in 48 proven cases of Epstein-Barr Virus infection and in 48 age- and sex-matched healthy controls to establish optimal cutoff values for diagnosing EBV infection. Predictive values were determined for individual EA and VCA antibody titers and for EA to VCA antibody ratios and the optimal dilution cutoff values for positivity of EA (1:20), VCA (1:640), and EA to VCA (0:031) were selected. When evaluated on a subset of 10 VCA IgM positive cases and 35 negative controls, the three selected cutoff values identified as infections nine of 10, four of 10, and 10 of 10 of the cases and one of 35, none of 35, and one of 35 of the controls, respectively. When evaluated individually on 22 cases of suspected EBV infection who were heterophile antibody-negative and presented with symptoms compatible with EBV infection, an equal number of VCA IgM-positive and negative cases were identified as EBV infections. Overall, the cutoffs EA, VCA, and ratio identified 19 of 22 (86.4%), 14 of 22 (63.6%), and 18 of 22 (81.8%), respectively, and all cases could be identified using combinations of these values. Although these serologic values may be used with some accuracy, until more definitive markers are described a combination of heterophile responses, lymphocyte analysis, clinical symptoms, and serologic cutoff values should be used to assess the role of EBV in patient evaluation.

Examination of the Rotazyme II enzyme immunoassay for the diagnosis of rotavirus gastroenteritis

Rotazyme II, which is a shorter version of Rotazyme (less than 3 h), was compared with electron microscopy and Rotazyme for sensitivity and specificity on 229 human stool specimens. Compared with electron microscopy, the newer assay was found to be 99.4% sensitive and 97.3% specific for an overall agreement of 98.7%. After resolution of discordant results by blocking tests, the Rotazyme II enzyme immunoassay was shown to be more sensitive than electron microscopy and, therefore, 100% specific.

Indirect immunofluorescence staining of Chlamydia trachomatis inclusions in microculture plates with monoclonal antibodies

Indirect immunofluorescence (IF) staining, using a monoclonal antibody, detected two- to fourfold more inclusions than did iodine staining. Of 274 clinical specimens, 53 (19.3%) were positive by IF on passage 1 as compared with 33 (12%) by iodine staining (P less than 0.005). IF-stained inclusions in McCoy cells in the bottom of microculture wells were readily viewed with a long-focal-length objective at a magnification of 250 X.

Demonstration of terminal deoxynucleotidyl transferase in single cells by indirect immunofluorescence. II. An examination of specificity

Advantages in the use of indirect immunofluorescence for the identification of terminal transferase (TdT) in single cells may be offset by lack of specificity, as compared to the biochemical assay of the enzyme, especially in analyses of lymphocyte populations. False positive results were obtained in 15/15 tonsillectomy samples and in 9/27 specimens from children with acute lymphoblastic leukemia in remission, perhaps due to antihuman lymphocyte activity in the rabbit heteroantisera which are used in the indirect immunofluorescence technique. This phenomenon may be more pronounced in 'activated' normal lymphocytes. Such reactions are not due to antibodies directed against adenovirus, papovavirus or EB virus antigens, although these are common constitutents of human tonsillar cells. Additional problems with TdT heteroantisera may result from immunization with non-TdT determinants in calf thymus extracts, as was manifest in human non-lymphoid (KB) cells cultured in fetal bovine serum. These difficulties will be overcome only by production of a monoclonal antibody using human TdT as the antigen.

Synthesis of a brain-specific protein (S100 protein) in a lectin-resistant mutant of a rat glial cell line (C6)

The synthesis of S100 protein increases toward the end of the exponential phase of growth of clonal rat glial cells C6 in monolayer culture. Moreover the synthesis of this protein can be increased by treatment of C6 cells with the lectin succinylated concanavalin A (succinyl ConA). In order to study the relationship between these two inductions of S100 protein we have isolated a cell line resistant to ConA from a population of C6 cells. The resistant cells (C6-ConAR) have less succinyl ConA receptors than C6 cells. In contrast to C6 cells, the synthesis of S100 protein does not increase in C6-ConAR cells after treatment with succinyl ConA. However in both cell types the synthesis of S100 protein increases toward the end of the exponential phase of growth. These results suggest firstly that the induction of S100 protein in C6 cells by succinyl ConA is mediated by an interaction of the lectin with its membrane receptors and secondly that the initial steps in the induction of S100 protein by the lectin are different from the initial steps in the induction of this protein which occurs toward the end of the exponential phase of growth in monolayer culture.

The synthesis of the brain specific S100 protein in colcemid resistant mutants of rat glial cells

We have isolated two colcemid-resistant mutant sublines, CMR (7A) and CMR (7B), from rat glial cells, C6, using multiple consecutive selections with increasing concentrations of colcemid. The mutant sublines show a decreased uptake of [3H]colchicine but have no apparent defect in the cytoplasmic binding of the drug. The synthesis of the brain-specific S100 protein is less sensitive to colcemid inhibition in the mutant cell lines than in parental C6 cells, suggesting that colcemid must enter the cell to inhibit S100 protein synthesis.

A monoclonal antiidiotypic antibody to MOPC 315 IgA inhibits the growth of MOPC 315 myeloma cells in vitro

Spleen cells from BALB/c mice immunized with MOPC 315 IgA were fused with P3X63/Ag8 myeloma cells. Hybrid clones were screened for antibody production by a plate-binding radioimmunoassay in which MOPC 315 IgA was reacted with culture supernatants and 125I-protein A. One antibody-producing hybridoma clone (D10) was selected and injected i.p. into BALB/c mice. Ascitic fluid of tum or-bearing animals reacted specifically with MOPC 315 IgA and the reaction was inhibited by DNP- aminocaproic acid, indicating that the monoclonal antibody was directed against the hapten-binding site of MOPC 315 IgA. The monoclonal antiidiotypic antibody was of the complement (C)-binding IgG2a subclass and inhibited IgA production and growth of MOPC 315 cells in vitro in the presence of guinea pig C, as assessed by inhibition of formation of plaques and colonies by MOPC 315 cells in agar.

A monoclonal antiidiotypic antibody to MOPC 315 IgA inhibits the growth of MOPC 315 myeloma cells in vitro

Spleen cells from BALB/c mice immunized with MOPC 315 IgA were fused with P3X63/Ag8 myeloma cells. Hybrid clones were screened for antibody production by a plate-binding radioimmunoassay in which MOPC 315 IgA was reacted with culture supernatants and 125I-protein A. One antibody-producing hybridoma clone (D10) was selected and injected i.p. into BALB/c mice. Ascitic fluid of tum or-bearing animals reacted specifically with MOPC 315 IgA and the reaction was inhibited by DNP- aminocaproic acid, indicating that the monoclonal antibody was directed against the hapten-binding site of MOPC 315 IgA. The monoclonal antiidiotypic antibody was of the complement (C)-binding IgG2a subclass and inhibited IgA production and growth of MOPC 315 cells in vitro in the presence of guinea pig C, as assessed by inhibition of formation of plaques and colonies by MOPC 315 cells in agar.

Induction of cytotoxic factors by immunization of mice with Freund's adjuvant components

Antiidiotypic antibody (AIA) was raised in mice by immunization with MOPC 315 immunoglobulin A emulsified in Freund's adjuvant (FA). The antibody content of mouse serum was assessed by (a) its ability to inhibit rosetting of 2,4,6-trinitro-phenyl-sheep red blood cells around MOPC 315 myeloma cells, and (b) by a solid phase antigen-binding plate assay based on reactivity with 125I-Protein A and inhibition in the presence of dinitrophenyl aminocaproic acid. FA was necessary for the production of AIA to MOPC 315 immunoglobulin A. Some of the AIA-containing mouse sera were cytotoxic for MOPC 315 cells in the presence of guinea pig complement. However, cytotoxicity was not correlated with amount of AIA, as assessed by inhibition of rosette formation, nor was it specific for myeloma cells bearing the MOPC 315 idiotype. Furthermore, cytotoxicity could also be generated by immunization of mice with complete Freund's adjuvant, incomplete Freund's adjuvant, or the muramyl dipeptide portion of mycobacteria, all in the absence of MOPC 315 immunoglobulin A. Therefore, the complement-dependent cytotoxic antibodies in the AIA-containing antisera, which belonged to the immunoglobulin G and M classes, were likely directed against some component of FA. Myeloma cells which were not killed by anti-FA antiserum, as assessed by dye exclusion, were inhibited in their ability to secrete immunoglobulin and to form clones in agar.

Synthesis of the brain-specific S-100 protein in a cell-free system from wheat embryo programmed with poly(A)-containing RNA from rabbit brain

Polyadenylated polysomal RNA was prepared from rabbit cerebral hemispheres using phenol extraction and chromatography on oligo(dT)-cellulose. This RNA directed the synthesis of the brain-specific S-100 protein in cell-free extracts from wheat embryo. S-100 protein was absent from the products of endogenous incorporation and from a reaction programmed with kidney mRNA. These results suggest that S-100 protein mRNA contains a poly(adenylic acid) sequence and rule out the necessity of a brain-specific factor for translation of -S100 protein mRNA.